«Glossary AIDS Acquired Immune Deficiency Syndrome ART Anti Retroviral Treatment CCM Country Coordinating Mechanism CSOs CIVIL SOCIETY ORGANIZATION ...»
This Report was prepared by cooperative efforts between different institution working in the
field of HIV/AIDS in Yemen.
It was initiated by NAP who sent an official letter to all governorates requesting them to submit
the annual report for AIDS cases and the implemented activities during 2013.
Another request sent to health facilities working in the blood transfusion and doing HIV screening test to sent their reports.
More over the NGOs working in HIV/AIDS have been requested to provide the annual report on the activities implemented in 2013 so NAP can start preparation of country progress report and submit the report in due time.
I extend the words of appreciation, gratitude and gratefulness to all the participant in the consultation meetings conducted to make consensus on the core indicators.
Special thanks to my colleagues from the NAP,NGOs, UN agencies UNAIDS,WHO, international NGOs for their great help and technical support Glossary AIDS Acquired Immune Deficiency Syndrome ART Anti Retroviral Treatment CCM Country Coordinating Mechanism
CSOs CIVIL SOCIETY ORGANIZATIONFsW Female Sex Workers
GF GLOBAL FUND
MOI MINSTERY OF INTERNALMENA Middle East and North Africa Region MOPH&P Ministry of Public Health and Population MSM Men having Sex with Men
NGOs NON GOVERNMENTAL ORGANIZATIONNAP National AIDS Program NSP National STRATEGIC PLAN
NTP NATIONAL T.B PROGRAM
PITC PROVIDE INTIATING TEST &COUNCELINGPLHIV People Living with HIV Prevention mother to child transmission PMTCT SOP Standard operating manual
STD SEXUAL TRANMMITED DISEASE
JOINT UNITED NATIONS PROGRAMME ON HIV
UNITED NATIO GENERA ASSEMBLSPECIAL SESSION
UNGASSUNDP United Nations Development Fund
WHO WORLD HEALTH ORGANIZATION
TABLE OF CONTENT:Acknowledgement 2 Glossary 3 Background 3 Epidemic status of HIV/AIDS 4 Core Indicators table 8 Prevention programs 12 Care and treatment 15 Best practice 16 MAJOR CHALLENGES AND REMEDIAL
Yemen is among the world’s least developed countries with estimated population size about 25 million (CSO, 2012). In spite of achieving some economic development over the past decade, poverty among the population is still high 34% of the total population and 18% of population are living in extreme poverty.
Yemen is a low prevalence for HIV which estimated 0.2% of the total population (2011 HIV size estimates/NAP). However the evidence showed that Yemen is having a concentrated HIV epidemic among men who have sex with men (MSM) with prevalence rate 5.9% (2011 study).
It is estimates that at the end of 2013 there are 35,000 people living with HIV in Yemen (NAP Report, 2013).
As a result of the political crisis in the country In 2011 and its significant negative impact on all development programs including HIV/AIDS control programs,most of the activities stopped.
The available government support was affected due to the changing priorities of the government during the crisis to be more focused on other areas such as internal displaced population (IDP), and emergencies in terms of provision of basic services including water, electricity, food and fuel.
This situation has been aggravated by the end of GF grant,closing of HIV project supported by UNICEF which resulted ultimately on the scarcity of resources for the NAP.
Fortunately, the Global Fund at this phase supported the continuity of treatment and care services for the period from January 2011 to December 2012 according to the continuation of services policy.
The same thing has been continued in the transitional funding mechanism 2013-2014 which was very limited for continuation of services for care and treatment for fixed number (631under ARVs,924 under OIs drug ).
The Epidemic status of HIV/AIDS :
Yemen is one of the countries with low prevalence of HIV (0.2%) in the general population according to 2011 HIV size estimates/NAP. Surveys among representative samples from general population e.g pregnant women and T.B patients assure the low prevalence rate, According to the Annual report from National AIDS Program (NAP 2013) cases increased from 1 in 1990 to the total accumulative number 3763 in 2013, However, the estimated number of HIV cases in Republic of Yemen is 35000 (2013 HIV size estimates/NAP).
The table (1) showed that the number of cases reported in the previous three years is less than the incidence before 2010.
Table (1)Distribution of Reported HIV cases by year from 1987 to 2013
1987 1 1988 3 1989 3 1990 6 1991 4 1992 44 1993 25 1994 26 1995 52 1996 96 1997 204 1998 189 1999 111 2000 110 2001 107 2002 151 2003 247 2004 214 2005 228 2006 254 2007 248 2008 241 2009 318 2010 354 2011 266 2012 261 2013 232
The figures indicated that the political security situation and conflict in the country during the year of 2011-2012, may affect the notification of new HIV cases which was low and 232 cases reported.
Most of the registered cases among male and the cases among female is increasing see the diagram below.
The majority of transmission is attributed to sexual transmission whether hetero- or homosexual, Hetero-sexual was the main rout of transmission 85% of the HIV cases, while the next most frequent mode of transmission was homosexual 6%.
Due to low prevalence rate,the National AIDS Program has altered its planning direction from studies and surveys among general population towards targeting most at risk population, A mapping and size estimation study of MSM and FSW was conducted in 2010 in capital cities of five governorates.
These included Sana’a, Hudeida, Mukalla, Aden and Taiz. The estimated total number of FSWs in all five areas surveyed ranged between 9,084 and 14,134, while that of MSM is between 7,990 and 11,819. Based on the population age 15 – 49 years for females and 10 – 59 years for males, the proportion of FSW and for MSM in each governorate was calculated. Extrapolating from the estimates in the five governorates and based on the total population of females aged between 15 and 49 the estimated number of FSW in Yemen is 58,934., the median proportion of FSWs in Yemen will range from 1.16% to 2.1%, For MSM the national median proportion is between 0.61% and 1.47% with the estimated number of MSM being 44,320 Bio-behavioural survey was conducted in Hodeida city in 2010 using the respondents driven sampling method targeting 301FSWs and the results revealed 0% HIV. Though no HIV infection, study reveals major behavioural risk factors being low age of sexual debut, low condom use among FSW, 34.88% had used condoms with the most recent client.
The study has shown that the FSW have a very low comprehensive knowledge of HIV and only a small proportion perceive themselves at higher risk of contracting HIV infection.
Also Bio-behavioral survey was conducted in Aden and Hodeida, among 261 MSM in 2011.
The mean age of respondents was 23.8 years (95% CI, 17.8-29.8). HIV prevalence was 5.9% (95% CI, 4.8-7.3). 27.8% had comprehensive knowledge about HIV preventive measures and rejected common misconceptions. In 31.4% of cases, either the respondents or their sexual partner(s) have reported STI symptoms in the past 12 months. About 1 % (95% CI, 0.1-9.2) reported injecting drugs in the past 12 months. The reported consistent condom use in past six months was less than 10% with different partners (including commercial sex). Only 20% (95% CI, 15.8-25) reported condom use in their last anal sex These implemented surveys indicate that HIV is an epidemic among the studies developed for MSM in Aden and Hodeida. Risk behaviors are frequent, and preventive measures are not utilized.
The previous studies confirmed that, there is a risk of transmission of HIV and other STIs between the members of the MARPs and from them to other vulnerable group and general population.
The need assessment has been conducted by international consultant who collected the data about the MARPs in 5 governorates and then he assessed the community system and the interventions implemented in the field targeting this groups.
The findings of facility and community assessment have been used in concurrence with international best practises to develop SoP addressing key functions in Targeted Interventions among MARPs. The SoP included steps in community outreach, BCC and VCT services and other interventions necessary for MARPs.
Due to the limitation of resource it was difficult to start comprehensive programs according to the recommendation and standards in the previous 3 years.
UNAIDS has supported one project in 3 governorates which need to be assessed and make recommendation for the future.
No new study have been conducted for MARPs and no more KAB studies for young population so we have used the same figures for most of core indicators based on the report submitted in the 2012 UNGASS report.
Only indicators (20 to 26 ) have been updated according to new data available from care and treatment services and PMTCT in addition to AIDS spending,2013 data have been added.
Prevention Programs The NAP with its partners from government and civil society organizations has reached a great
achievement during the last period until the end of 2013 in various fields, including the following:
Although there was still a high level of stigma and discrimination against PLWH in Yemen, awareness in the field of AIDS has been given in 2012 and 2003 great attention and support in Yemen compared to 2008, which has had an impact in educating different groups of society and consequently changing behavior. This was accomplished through the implementation of awareness lectures and seminars and campaigns on AIDS in addition to the services provided in the field of voluntary counseling and testing, medical care and treatment, PMTCT services to a great number of target groups.
In 2013, the number of beneficiaries was 156276 persons from different community segments, school and university students, journalists and employees of the armed forces and security and other target groups.
NAP with support of MSF start the process for improvement of hot line services by updating the information recorded in the automatic reply machine.
General information on AIDS, mode of transmission, ways for prevention have been inserted and enough information on the services available have been recorded.
On the occasions of the World Day to Combat AIDS, numbers of publications and educational materials on AIDS and other sexually transmitted diseases and the services provided in the field of care, treatment, counseling and testing services and prevention of infection services were about (250,000) leaflets and brochures distributed in 2013.
Awareness campaign has targeted youth in schools & universities, general population in Malls & Parks.
IEC materials printed & distributed. The campaign was conducted with Yemen Aid association, Field Medical Foundation, Tamkeen for Development & No Stigma Foundations, Youth initiative, Yemen Reproductive Health Association, Faculty of medicine & Faculty of Dentistry in Aden University Also the establishment of HIV Advocacy Platform in collaboration with MSF-Spain, NAP –MOPHP, CSOs, WHO,UNHCR More awareness activities have been implemented by different national and international NGOs (see the annyx table about awareness activities in 2013) TV and radio seminars, interviews, awareness flashes have also been conducted in the Yemen TV,private channels, and local radio stations about AIDS and the services provided to combat AIDS, treatments and prevention of infection, counseling and testing services.
The workshops and awareness programs and meetings organized by the NAP in cooperation and coordination with civil society organizations and international organizations and donors through various levels have been covered at the central level and governorates media (radio, television and newspapers).
HIV Testing and Counseling Counseling and testing (T&C) formed the priority number 6 in the “National Strategy Framework”. The support of WHO consultant has updated the National testing and counseling guideline and training manuals to ensure general confidential testing for all in need groups in the community. Moreover, there was initiation of the provider initiative testing and counseling services (PITC) which was integrated with in a number of public health facilities and NGOs to strengthen and encourage access to this preventive measure. Thus a PITC operational manual and training guide has been developed for both public and non-governmental organizations providing HIV testing and counseling services.
During the period of 2013 the testing and counseling centers that have been established 32 centers.
With the support of WHO, several training workshops for counselors were conducted as well as mentoring of health providers in 3 governorates (Sana’a, Aden and Al-Hodeidah) and mentoring of the newly established testing and counseling sites in Haja, Al-mokalah, Lahj, Al-Mahra and Syooun by NAP.
A growing access to T&C services was observed but still limited reaching a cumulative number of 5378 clients tested through VCT and PITC sites in addition to out reach programs.